LAUSR

As a fellow Oxford medical student, I read with great interest your article by de Andres Crespo (2020). The author contends that medical schools’ lack of practical surgical training contributes to declining surgical applications. From my experience, other factors weigh more heavily in students’ aversion to surgery. Studies have shown that medical students generally decide to specialise in surgery early 90% of eventual surgeons indicated this preference in first year of medical school (Goldacre et al. 2010). Furthermore, ‘matching’ between early preference and eventual career was greater for surgery than other specialties. These data seem to dispute the assertion that medical school opportunities significantly influence waning surgical applications. However, it does unfortunately suggest that very few students without early preferences for surgery are inspired to specialise as surgeons. Work-life balance and training duration are commonly cited reasons for dissuasion from surgical careers (Glynn and Kerin 2010). Medical schools are unlikely to alter such preferences, but could they do more to inspire new budding surgeons from ambivalent medical students? Oxford facilitates multiple surgical placements, and numerous university-arranged surgical skills sessions. I suggest that failure to produce new aspiring surgeons arises from uninspiring or unappealing clinical placements, not lack of surgical teaching. A brief survey of fellow students suggested that: not scrubbing in, standing far back in theatre, and not having procedures explained, are exceedingly common occurrences. Such experiences are thoroughly disillusioning, and many students admittedly dread surgical placements for this reason. Furthermore, cultural issues persist, frequently discouraging students from surgery. For instance, misogynistic jokes made in the presence of female students, and being mocked for non-surgical aspirations. I feel these factors contribute heavily to the lack of medical students developing surgical aspirations whilst attending medical school. Whilst the student-led surgical skills course the author created may maintain the preference of already prospective surgeons – it likely will not inspire new surgical preferences, as students without surgical interests may not attend. I believe the solution is for medical schools to clearly outline to surgical tutors what students should experience on surgical placements. This should include scrubbing in, involvement with procedures and explanation of relevant surgical principles. From my experience, this evokes greater engagement with surgery, and is much more likely to inspire future surgeons.